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Sexually Transmitted Diseases Summary of
2015 CDC Treatment Guideline Guideliness
These summary guidelines reect the June 2015 update to the 2010 CDC Guidelines for Treatment of Sexually Transmitted Diseases. This summary is intended as a source of clinical guidance. When more than one therapeutic regimen is recommended the sequence is in alphabetical order unless the choices for therapy are prioritized based on efcacy, cost, or convenience. The recommended regimens should be used primarily; alternative regimens can be considered in instances of substantial drug allergy or other contraindications. An important component of STD treatment is partner management. Providers can arrange for the evaluation and treatment of sex partners either directly or with assistance from state and local health departments. Complete guidelines can be viewed online at www.cdc.gov/std/treatment.
This booklet has been reviewed by the CDC 6/2015. Indicates update from the 2010 CDC Guidelines for the Treatment of Sexually Transmitted Diseases.
Bacterial Vaginosis
Lymphogranuloma venereum
Cervicitis
Non-Gonococcal Urethritis (NGU)
Chlamydial Infections
Pediculosis Pubis
Epididymitis
Pelvic Infammatory Disease
Genital Herpes Simplex
Scabies
Genital Warts (Human Papillomavirus)
Syphilis
Gonococcal Infections
Trichomoniasis
Bacterial Vaginosis Recommended Rx metronidazole oral1
OR 500 mg orally 2x/day for 7 days
metronidazole gel 0.75%1
OR One 5 g applicator intravaginally 1x/ day for 5 days
clindamycin cream 2%1,2
Treatment is recommended for all symptomatic pregnant women.
Bacterial
Dose/Route
One 5 g applicator intravaginally at bedtime for 7 days
Alternatives tinidazole 2 g orally 1x/day for 2 days tinidazole 1 g orally 1x/day for 5 days clindamycin 300 mg orally 2x/day for 7 days clindamycin ovules 100 mg intravaginally at bedtime for 3 days
OR OR OR
Cervicitis
Cervicitis Recommended Rx azithromycin doxycycline3
Dose/Route OR 1 g orally in a single dose 100 mg orally 2x/day for 7 days
Consider concurrent treatment for gonococcal infection if at risk of gonorrhea or lives in a community where the prevalence of gonorrhea is high. Presumptive treatment with antimicrobials for C. trachomatis and N. gonorrhoeae should be provided for women at increased risk (e.g., those aged <25 years and those with a new sex partner, a sex partner with concurrent partners, or a sex partner who has a sexually transmitted infection), especially if follow-up cannot be ensured or if NAAT testing is not possible.
Alternatives
Chlamydial Infections Recommended Rx Adults and adolescents
Pregnancy3
azithromycin doxycycline4
OR
azithromycin8
Dose/Route 1 g orally in a single dose 100 mg orally 2x/day for 7 days
1 g orally in a single dose
Alternatives erythromycin base5 500 mg orally 4x/day for 7 days erythromycin ethylsuccinate6 800 mg orally 4x/day for 7 days levooxacin7 500 mg 1x/day orally for 7 days ooxacin9 300 mg orally 2x/day for 7 days
OR
amoxicillin 500 mg orally 3x/day for 7 days erythromycin base5,9 500 mg orally 4x/day for 7 days erythromycin base 250 mg orally 4x/ day for 14 days erythromycin ethylsuccinate 800 mg orally 4x/day for 7 days erythromycin ethylsuccinate 400 mg orally 4x/day for 14 days
OR
Infants and Children (<45 kg): urogenital, rectal
erythromycin base10 ethylsuccinate
OR
50 mg/kg/day orally (4 divided doses) daily for 14 days
Data are limited on the effectiveness and optimal dose of azithromycin for chlamydial infection in infants and children < 45 kg
Neonates: opthalmia neonatorum, pneumonia
erythromycin base10 ethylsuccinate
OR
50 mg/kg/day orally (4 divided doses) daily for 14 days
azithromycin 20 mg/kg/day orally, 1 dose daily for 3 days
Chlamydial
OR OR
OR OR OR
Epididymitis
Epididymitis
11,12
Recommended Rx For acute epididymitis most likely caused by sexually transmitted CT and GC For acute epididymitis most likely caused by sexuallytransmitted chlamydia and gonorrhea and enteric organisms (men who practice insertive anal sex) For acute epididymitis most likely caused by enteric organisms
Dose/Route
ceftriaxone doxycycline
PLUS
250 mg IM in a single dose 100 mg orally 2x/day for 10 days
ceftriaxone levooxacin ooxacin
PLUS OR
250 mg IM in a single dose 500 mg orally 1x/day for 10 days 300 mg orally 2x/day for 10 days
levooxacin ooxacin
OR
500 mg orally 1x/day for 10 days 300 mg orally 2x/day for 10 days
Alternatives
Genital Herpes Simplex Recommended Rx
Dose/Route
First clinical episode of genital herpes
acyclovir acyclovir valacyclovir 13 famciclovir 13
OR OR OR
400 mg orally 3x/day for 7-10 days14 200 mg orally 5x/day for 7-10 days14 1 g orally 2x/day for 7-10 days14 250 mg orally 3x/day for 7-10 days14
Episodic therapy for recurrent genital herpes
acyclovir acyclovir acyclovir valacyclovir 13 valacyclovir 13 famciclovir 13 famciclovir 13 famciclovir 13
OR OR OR OR OR OR OR
400 mg orally 3x/day for 5 days 800 mg orally 2x/day for 5 days 800 mg orally 3x/day for 2 days 500 mg orally 2x/day for 3 days 1 g orally 1x/day for 5 days 125 mg orally 2x/day for 5 days 1000 mg orally 2x/day for 1 day14 500 mg orally once, followed by 250 mg 2x/day for 2 days
Suppressive therapy15 for recurrent genital herpes
acyclovir valacyclovir 13 valacyclovir 13 famciclovir 13
OR OR OR
400 mg orally 2x/day 500 mg orally once a day 1 g orally once a day 250 mg orally 2x/day
Recommended regimens for episodic infection in persons with HIV infection
acyclovir valacyclovir 13 famciclovir 13
OR OR
400 mg orally 3x/day for 5-10 days 1 g orally 2x/day for 5-10 days 500 mg orally 2x/day for 5-10 days
Recommended regimens for daily suppressive therapy in persons with HIV infection
acyclovir valacyclovir 13 famciclovir 13
OR OR
400-800 mg orally 2-3x/day 500 mg orally 2x/day 500 mg orally 2x/day
Genital Herpes
Alternatives
Genital Warts (Human Papillomavirus)
Genital Warts (Human Papillomavirus) Recommended Rx External genital and perianal warts
Dose/Route
Patient Applied imiquimod 3.75% or 5% 13 cream
OR
podolox 0.5%13 solution or gel
OR
16
Alternatives
See complete CDC guidelines.
sinecatechins 15% ointment2,13 Provider Administered Cryotherapy
OR
trichloroacetic acid or bichloroacetic acid 80%-90% OR surgical removal
Apply small amount, dry, apply weekly if necessary
podophyllin resin 10%–25% in compound tincture of benzoin may be considered for provideradministered treatment if strict adherence to the recommendations for application. intralesional interferon photodynamic therapy topical cidofovir
OR
OR OR
17
Gonococcal Infections Recommended Rx Adults, adolescents: uncomplicated gonococcal infections of the cervix, urethra, and rectum
ceftriaxone
Dose/Route
PLUS
250 mg IM in a single dose 1 g orally in a single dose
azithromycin10
Alternatives If ceftriaxone is not available: cexime 400 mg orally in a single dose azithromycin8 1 g orally in a single dose
PLUS
If cephalosporin allergy: gemioxacin 320 mg orally in a single dose azithromycin 2 g orally in a single dose
PLUS
gentamicin 240 mg IM single dose azithromycin 2 g orally in a single dose Pharyngeal
ceftriaxone
PLUS
1 g orally in a single dose
azithromycin10 Pregnancy3
See complete CDC guidelines.
Adults and adolescents: conjunctivitis
ceftriaxone
Children (≤45 kg): urogenital, rectal, pharyngeal
250 mg IM in a single dose
PLUS
1 g IM in a single dose
azithromycin10
1 g orally in a single dose
ceftriaxone18
25-50 mg/kg IV or IM, not to exceed 125 mg IM in a single dose
Gonococcal
OR PLUS
Lymphogranuloma venereum
Lymphogranuloma venereum Recommended Rx doxycycline4
Dose/Route
Alternatives
100 mg orally 2x/day for 21 days
erythromycin base 500 mg orally 4x/day for 21 days
Nongonococcal Urethritis (NGU) Recommended Rx azithromycin8 doxycycline4
Persistent and recurrent NGU3,19,20
Dose/Route OR
1 g orally in a single dose 100 mg orally 2x/day for 7 days
Men initially treated with doxycycline: azithromycin
1 g orally in a single dose
Men who fail a regimen of azithromycin: moxioxacin
400 mg orally 1x/day for 7 days
Heterosexual men who live in areas where T. vaginalis is highly prevalent: metronidazole21 tinidazole
OR
2 g orally in a single dose 2 g orally in a single dose
Non-Gonococcal Urethritis (NGU)
Alternatives erythromycin base5 500 mg orally 4x/day for 7 days erythromycin ethylsuccinate6 800 mg orally 4x/day for 7 days levooxacin 500 mg 1x/day for 7 days ooxacin 300 mg 2x/day for 7 days
OR OR OR
Pediculosis Pubis
Pediculosis Pubis Recommended Rx permethrin 1% cream rinse pyrethrins with piperonyl butoxide
Dose/Route OR
Apply to affected area, wash off after 10 minutes Apply to affected area, wash off after 10 minutes
Alternatives malathion 0.5% lotion, applied 8-12 hrs then washed off ivermectin 250 µg/kg orally, repeated in 2 weeks
OR
Pelvic Infammatory Disease Recommended Rx Parenteral Regimens Cefotetan Doxycycline
Cefoxitin Doxycycline
11
Dose/Route
Alternatives
PLUS OR
2 g IV every 12 hours 100 mg orally or IV every 12 hours
Parenteral Regimen Ampicillin/Sulbactam 3 g IV every 6 hours
PLUS
2 g IV every 6 hours 100 mg orally or IV every 12 hours
Doxycycline 100 mg orally or IV every 12 hours
Recommended Intramuscular/Oral Regimens Ceftriaxone PLUS Doxycycline WITH or
250 mg IM in a single dose 100 mg orally twice a day for 14 days
WITHOUT
Metronidazole
OR
500 mg orally twice a day for 14 days
Cefoxitin Probenecid Doxycycline
PLUS PLUS
2 g IM in a single dose 1 g orally administered concurrently in a single dose 100 mg orally twice a day for 14 days
WITH or WITHOUT
Metronidazole
500 mg orally twice a day for 14 days
The complete list of recommended regimens can be found in CDC’s 2015 STD Treatment Guidelines.
Pelvic Infammatory
PLUS
Scabies
Scabies Recommended Rx permethrin 5% cream
ivermectin
OR
Dose/Route Apply to all areas of body from neck down, wash off after 8-14 hours 200 µg/kg orally, repeated in 2 weeks
Alternatives 22,23
lindane 1% 1 oz. of lotion or 30 g of cream, applied thinly to all areas of the body from the neck down, wash off after 8 hours
Syphilis Recommended Rx
Dose/Route
Alternatives
Primary, secondary, or early latent <1 year
benzathine penicillin G
2.4 million units IM in a single dose
doxycycline7,24 100 mg 2x/day for 14 days OR tetracycline7,24 500 mg orally 4x/day for 14 days
Latent >1 year, latent of unknown duration
benzathine penicillin G
2.4 million units IM in 3 doses each at 1 week intervals (7.2 million units total)
doxycycline7,24 100 mg 2x/day for 28 days OR tetracycline7,24 500 mg orally 4x/day for 28 days
Pregnancy3
See complete CDC guidelines.
Neurosyphilis
aqueous crystalline penicillin G
18–24 million units per day, administered as 3–4 million units IV every 4 hours or continuous infusion, for 10–14 days
procaine penicillin G 2.4 MU IM 1x daily PLUS probenecid 500 mg orally 4x/day, both for 10-14 days.
Congenital syphilis
See complete CDC guidelines.
Children: Primary, secondary, or early latent <1 year
benzathine penicillin G
50,000 units/kg IM in a single dose (maximum 2.4 million units)
Children: Latent >1 year, latent of unknown duration
benzathine penicillin G
50,000 units/kg IM for 3 doses at 1 week intervals (maximum total 7.2 million units)
See CDC STD Treatment guidelines for discussion of alternative therapy in patients with penicillin allergy.
Syphilis
Trichomoniasis
Trichomoniasis Recommended Rx metronidazole21 tinidazole25 Persistent or recurrent trichomoniasis
OR
metronidazole If this regimen fails: metronidazole tinidazole If this regimen fails, susceptibility testing is recommended.
Dose/Route 2 g orally in a single dose 2 g orally in a single dose 500mg orally 2x/day for 7 days
OR
2g orally for 7 days 2g orally for 7 days
Alternatives metronidazole21 500 mg 2x/day for 7 days
Notes 1.
The recommended regimens are equally efcacious.
2.
These creams are oil-based and may weaken latex condoms and diaphragms. Refer to product labeling for further information.
3.
Please refer to the complete 2015 CDC Guidelines for recommended regimens.
4.
Should not be administered during pregnancy, lactation, or to children <8 years of age.
5.
If patient cannot tolerate high-dose erythromycin base schedules, change to 250 mg 4x/day for 14 days.
6.
If patient cannot tolerate high-dose erythromycin ethylsuccinate schedules, change to 400 mg orally 4 times a day for 14 days.
7.
Contraindicat ed for pregnant or lactating women.
8.
Clinical experience and published studies suggest that azithromycin is safe and effective.
9.
Erythromycin estolate is contraindicated during pregnancy.
10.
Effectiveness of erythromycin treatment is approximately 80%; a second course of therapy may be required.
11.
Patients who do not respond to therapy (within 72 hours) should be re-evaluated.
12.
For patients with suspected sexually transmitted epididymitis, close follow-up is essential.
13.
No denitive information available on prenatal exposure.
14.
Treatment may be extended if healing is incomplete after 10 days of therapy.
Indicates update from the 2010 CDC Guidelines for the Treatment of Sexually Transmitted Diseases.
Notes
Notes (continued)
Notes (continued) 15.
Consider discontinuation of treatment after one year to assess frequency of recurrence.
16.
Vaginal, cervical, urethral meatal, and anal warts may require referral to an appropriate specialist.
17.
CDC recommends that treatment for uncomplicated gonococcal infections of the cervix, urethra, and/or rectum should include dual therapy, i.e. both a cephalosporin (e.g. ceftriaxone) plus azithromycin.
18.
CDC recommends that cexime in combination with azithromycin or doxycycline be used as an alternative when ceftriaxone is not available.
19.
Only ceftriaxone is recommended for the treatment of pharyngeal infection. Providers should inquire about oral sexual exposure
20.
Moxioxacin 400mg orally 1x/day for 7 days is effective against Mycoplasma genitalium.
21.
Pregnant patients can be treated with 2 g single dose.
22.
Contraindicated for pregnant or lactating women, or children <2 years of age.
23.
Do not use after a bath; should not be used by persons who have extensive dermatitis.
24.
Pregnant patients allergic to penicillin should be treated with penicillin after desensitization.
25.
Randomized controlled trials comparing single 2 g doses of metronidazole and tinidazole suggest that tinidazole is equivalent to, or superior to, metronidazole in achieving parasitologic cure and resolution of symptoms.
Indicates update from the 2010 CDC Guidelines for the Treatment of Sexually Transmitted Diseases.
